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Post by silentbob on Mar 1, 2015 17:19:29 GMT -5
I posted this on the AfrezzaUser thread in the articles board. I think this is groundbreaking enough to post here as well, since he recreated the bolus-without-a-meal trial successfully: afrezzauser.com/testing-the-limits-of-afrezza-unbelievable/Stunning! Even though we knew this 'in theory', it still required major cohones to be the first to try this at home! Respect, AfrezzaUser...
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Post by goyocafe on Mar 1, 2015 18:30:00 GMT -5
When I first saw the first photo, I thought that was a car battery up against the wall. My first thought was, "Wow! He's taking no chances, he even has a home made defibrillator on standby!"
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Post by liane on Mar 1, 2015 19:47:35 GMT -5
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Post by xoxoxoxo on Mar 1, 2015 19:48:05 GMT -5
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Post by liane on Mar 1, 2015 19:54:19 GMT -5
Yes, BS will keep dropping as the RAA is in your system for a much longer period of time. Eventually, if the BS drops far enough (30's or so), a person may be unable to help them self, and would lapse into a coma.
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Post by tripoley on Mar 1, 2015 20:22:14 GMT -5
Look at the pharmacodynamics (PD) part of the chart on the left. See all that area under the curve after the 8 units of lispro? It peaks at 2+ hours and hangs around until it matchs Afrezza at about six hours. Afrezza does most of it's work between 30 and 60 minutes and rapidly declines after that. Attachment Deleted
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Post by xoxoxoxo on Mar 1, 2015 21:39:16 GMT -5
I get all that, but let's assume a diabetic knows that 4u drops their BG by 50 pts. What's the big deal with taking it on an empty stomach and dropping 50 pts in 30 minutes vs 2-3 hours?
My assumption here is that 4u of Afrezza drops BG the same as 4u of humalog. I know that everyone is different, so maybe it's equal to 5u of humalog, but for this situation just assume we know what equal doses are.
Is there anything special about not eating when taking insulin? If Afrezzauser was at 70, didn't eat, and took 4u of Afrezza he'd still drop to 20 and have a nice hypo, right? Is the point that the hypo from going down to 20 only would be a few minutes before it starts to trend back up?
I don't entirely understand in the example AU posted why his BG would start trending back up after it hit 50.
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Post by ezrasfund on Mar 1, 2015 22:15:52 GMT -5
I get all that, but let's assume a diabetic knows that 4u drops their BG by 50 pts. What's the big deal with taking it on an empty stomach and dropping 50 pts in 30 minutes vs 2-3 hours? My assumption here is that 4u of Afrezza drops BG the same as 4u of humalog. I know that everyone is different, so maybe it's equal to 5u of humalog, but for this situation just assume we know what equal doses are. Is there anything special about not eating when taking insulin? If Afrezzauser was at 70, didn't eat, and took 4u of Afrezza he'd still drop to 20 and have a nice hypo, right? Is the point that the hypo from going down to 20 only would be a few minutes before it starts to trend back up? I don't entirely understand in the example AU posted why his BG would start trending back up after it hit 50. This assumption is incorrect. Succinctly explaining why is more difficult, but this is just what Afrezzauser is demonstrating most dramatically with his reenactment of the zero carb experiment.
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Post by gomnkd on Mar 1, 2015 22:26:57 GMT -5
1) 4U Afrezza has much lower area under the GIR curve than 4u of huma/Novolog. 2) the place where It bottoms out is where you get inflection point in Afrezza. ie you have less and less effect from Afrezza. 3) Why does BG go up? perhaps due to hepatic glucose suppression, you got liver start sending glucose. Think of MC Hammer, he got lots of money, he spent everything and also his savings. When he was broke, he was totally broke. with new paradigm (Afrezza), when you get money you don't tap into savings account. only when you lose a job, you tap into savings. you use savings as a cushion. This is a crude analogy, hope it helps.
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Post by ezrasfund on Mar 1, 2015 22:53:58 GMT -5
Another piece of the puzzle. The high spike of insulin in Afrezza suppresses the hepatic glucose production, so when blood glucose drops (to about 50?) the liver kicks in and raises glucose to fasting levels. With Humalog the insulin spike may not be sufficient to completely suppress hepatic gluco-genesis, so when blood glucose levels drop too low the liver's response is too weak. Additionally it is too weak because Humalog's excess insulin is still in the blood while Afrezza is completely cleared. There are several complex mechanisms at work here. (Is there a biochemist in the house?)
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Post by afrezzauser on Mar 1, 2015 23:05:02 GMT -5
If I took 4u of an injectable starting at a 100 without any food I would not be talking to you right now. You mentioned something about dropping to 20 and curving up from there. No, that is not correct. If you drop to 20 it is too late for you! Dropping under 40 is getting close to life and death game. Under 30, you are in trouble. Under 25, you have seconds or minutes to save yourself. The problem is your mind and muscles are already shutting down the lower you go so even if you know something is wrong you are not able to do anything about it. I have been there and done that many times on injectables. When you have a severe low it is like death coming knocking on your door. You know it is coming and if you are out of a source of quick sugar that's it for you. I have been caught off guard many times having lows hours later where I forget to have emergency sugars with me. People are not understanding the process between Afrezza and the liver but sooner or later they will. Read paragraph 3 www.endocrineweb.com/conditions/type-1-diabetes/what-insulinAfrezza delivers first phase insulin, meaning insulin in the first 15 minutes of delivery which in turn suppresses hepatic glucose production lowering fasting glucose in the am and also post-meal glucose. This also kicks in other other things. So it is not as simple as how many units of injectable = Afrezza. Afrezza works almost as a smart insulin when you take into account its interaction with the liver. Bottom line for me it does not matter why or how it happens. I wake up in the morning with sugars in the 70s and 80s and average out around 92 to 105 every day. I am maintaining what equals to an a1c of 4.8 to 5.4 if I would do this for 90 days. I do this with no severe lows and I never have severe highs. Even if I would I can knock it down to normal range in an hour every time. I am living like a non-diabetic and in my mind I am cured and thats all that matters.
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Post by afrezzauser on Mar 1, 2015 23:06:37 GMT -5
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Post by mnkdd on Mar 1, 2015 23:16:09 GMT -5
That was an amazing blog post, Sam F.! Hope you had someone watching over you during the experiment!
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Post by savzak on Mar 1, 2015 23:23:15 GMT -5
Very good thread. This issue is the crucial issue for Afrezza's widespread acceptance. I'm becoming convinced that early adopters like Sam will ultimately be all that's needed to spread the word among diabetics and thus engender a momentum that will be unavoidable by healthcare professionals who will ultimately be forced to see this for what it is. Still, I'm hopeful that Sanofi understands this point very well and is emphasizing, and then reemphasizing it with each opportunity.
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Post by xoxoxoxo on Mar 1, 2015 23:24:03 GMT -5
Thanks for the responses. I'm still stuck on the concept of thinking that similar doses of each type of insulin will always lower your BG by the same amount, but am beginning to understand. Obviously there's a lot more going on behind the scenes with the liver that what the average diabetic understands. I was a kid the first time my dad went hypoglycemic exactly as you described it... Grabbing his wallet and rushing to the vending machine to buy a coke. Hopefully that becomes a thing of the past.
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